Psychiatric Comorbidity of Chronic Daily Headache: Focus on Traumatic Experiences in Childhood, Post-Traumatic Stress Disorder and Suicidality
Current Pain and Headache Reports (Impact Factor: 2.26). 04/2014; 18(4):405. DOI: 10.1007/s11916-014-0405-8
The fifth edition of the Diagnostic and Statistic Manual (DSM-5) reclassified some mental disorders recently. Post-traumatic stress disorder (PTSD) is in a new section termed "trauma- and stressor-related disorder". Community-based studies have shown that PTSD is associated with a notably high suicidal risk. In addition to previous findings of comorbidity between chronic daily headache (CDH) and both depressive disorders and anxiety disorders, recent data suggest that frequency of childhood maltreatment, PTSD, and suicidality are also increased in CDH. CDH patients with migraine aura are especially at risk of suicidal ideation. Research suggests that migraine attack, aura, frequency, and chronicity may all be related to serotonergic dysfunction. Vulnerability to PTSD and suicidality are also linked to brain serotonin function, including polymorphisms in the serotonin transporter gene (5-HTTLPR). In the present review, we focus on recent advances in knowledge of traumatic experiences in childhood, PTSD, and suicidality in relation to migraine and CDH. We hypothesize that vulnerability to PTSD is associated with migraine attack, migraine aura, and CDH. We further postulate that these associations may explain some of the elevated suicidal risks among patients with migraine, migraine aura, and/or CDH. Field studies are required to support these hypotheses.
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ABSTRACT: Neurotrophic factors have been implicated in hyperalgesia and peripheral levels of these molecules were altered in behavioral and neurological disorders. The objectives of this study were to assess neurotrophic factors levels in migraine patients in comparison with controls, and to investigate whether there was any association between them and clinical parameters. This was a cross-sectional study. We measured serum levels of neurotrophin family members – nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin 3 and 4/5 (NT3 and NT4/5) – and glial cell line-derived factor (GDNF) in patients suffering from migraine and matched controls. One hundred forty-one people were enrolled in this study, seventy-one were migraine patients and seventy were controls. Migraine patients showed more depressive and anxiety symptoms than control individuals as assessed, respectively, by the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory. Chronic and episodic migraine patients showed higher NT4/5 levels than control individuals (P = 0.001). Patients with chronic migraine had lower levels of BDNF that were not influenced by the presence of depressive symptoms (P = 0.02). This is the first report to evaluate NT3 and NT-4/5 levels in migraine patients. Our findings suggest a possible role of neurotrophic factors in migraine pathophysiology.
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ABSTRACT: Introduction: Headache is one of the most common chronic disease affecting around 152 millions of people in Europe, with a man: woman ratio of 1:3. Recent studies show that headache causes significant limitations in daily life with effects on emotional-behavioural and relational aspects. In particular the migraine headache, whose onset is often at a young age, that is the phase of maximum working, social and familiar activity. The aims of this study were to investigate the relationship between migraine-related disability and the presence of anxiety and depression in order to assess how the disability affects the patient activities. Materials and methods: We enrolled 123 migraine patients. All information related to headache was collected by means of interviews, examination of medical records, psychometric tests for measuring anxiety, depression and disability scale. Demographic and clinical characteristics, such as gender, age, education, pain intensity, and frequency of headache were also collected. Results: There was a significant difference in Hamilton Rating Scale for Anxiety and Hamilton Rating Scale for Depression scores between patients who declared to suffer from headache until 10 days per trimester, and patients who declared more than 10 days (p < 0.05 in both cases). Logistic regression analysis identified gender, age and migraine frequency as feasible risk factors; the migraine intensity was not significant (p = 0.96), as well as the diagnostic category (p = 0.3). Especially moderate headache frequency and female gender were the highest risk factors for a co-morbidity of anxiety and depressive disorders and pain intensity. Conclusion: Migraine condition may involve the onset of a severe disability. Indeed, independently from the diagnostic category, an high degree of disability is often related to the presence of anxious and depressive symptoms.
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ABSTRACT: Background: While numerous studies have explored relevant factors of posttraumatic stress disorder (PTSD) symptoms, there have been few joint investigations of trauma severity and trait neuroticism on the development of PTSD symptoms. This study aims to assess the involvement and interrelationship of trauma severity and neuroticism in the expression of PTSD symptoms among adolescents exposed to an accidental explosion. Methods: Six hundred and sixty-two adolescents were recruited from a junior middle school closest to the 2013 pipeline explosion site in China and were assessed using the Explosion Exposure Questionnaire, the NEO Five Factor Inventory-Neuroticism Subscale (FFI-N), and the PTSD Checklist-Civilian (PCL-C). A battery of hierarchical multiple regression analyses and two-way ANOVAs were performed to examine the effect of trauma severity and trait neuroticism on adolescent PTSD symptoms. Results: Eighty-seven adolescents (13.1%) showed PTSD symptoms after the pipeline explosion. Correlation analysis showed that all the factors of explosion exposure and trait neuroticism were positively associated with adolescent PTSD symptoms. Being male and younger was linked to lower risk for PTSD symptoms. The regression models identified explosion exposure and neuroticism as independent risk factors for PTSD symptoms, and the interactions between trait neuroticism and trauma exposure (personal casualty, degree of influence, total traumatic severity) were related to PTSD symptoms. Conclusions: The results highlight the role of trauma exposure and trait neuroticism as risk factors for PTSD symptoms. Therefore, the combination of these two factors should be investigated in clinical settings due to an augmented risk for more severe PTSD symptoms.
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